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Preti, M. et. al.-- 12 pages, 16 figures, 2 tables

We studied the frequency and distribution of cellular atypia in 448 cases of vulvar dystrophy. The total frequency was 9.4%. Atypia was found almost exclusively in hyperplastic areas. Epithelial changes suggestive of human papillomavirus infection were found in 14.2% of the atypical dystrophies. During the follow-up of 78 patients with typical dystrophy, mild atypia developed in three cases, but with the continuation of medical treatment it disappeared in two cases. Eleven cases of atypical dystrophy were followed for 3-48 months; three patients with severe atypia underwent surgical treatment, and eight with mild atypia underwent medical treatment. Among the last patients, six showed regression and two, progression of the atypia.

Human papillomavirus subclinical lesions are well known on the cervix and are identified by colposcopy after acetic acid staining. The transfer of this technique from the cervix to the vulva has led to the identification of areas of white epithelial changes which have been defined by similarity as vulvar subclinical HPV (VSHPV) lesions. A critical revision of the different clinical VSHPV lesions classifications, the vulvar diagnostic role of acetic acid staining, the natural history of HPV infection and the histological-biomolecular diagnostic techniques has the authors to the conclusions that the majority of the "so called" VSHPV lesions should not be considered a real disease. The presence of HPV-DNA in these subclinical lesions should be considered causal and not causal. To avoid overtreatments in women with proven HPV-DNA positivity without macroscopic clinical lesions, the authors recommend to abandon the acetic acid staining on the vulva and invite to consider the VSHPV lesions a faked diagnosis and not a clinical entity.

Twenty-one women were treated surgically for entry dyspareunia and vulvodynia. The ages of the patients ranged from 18 to 39 years (mean, 24.5). Physical examination showed the presence of membranous hypertrophy of the posterior fourchette with consequent stricture of the vaginal introitus in all the patients. Eighty percent of the patients had erythema and tenderness of the vestibule, particularly in the posterior part. The histologic findings were somewhat enigmatic and quite unimpressive, frequently suggestive of chronic nonspecific inflammation; in only two cases were histologic changes suggestive of human papillomavirus infection observed. All the patients underwent excision of the posterior part of the vestibule with vaginal advancement under general anesthesia. Follow-up showed elimination of the symptoms in 19 patients and an improvement in the symptoms in the remaining 2.

Objective To determine the influence of cognitive functioning on gait recovery after total hip arthroplasty. Design Prospective cohort study. Setting Rehabilitation hospital. Participants Patients (N=40) who underwent a total hip arthroplasty, with normal cognitive functioning and without any other relevant medical condition, were recruited and studied before surgery and at the beginning and the end of the rehabilitation program. Main Outcome Measures Gait speed (10-Meter Walk Test [10MWT]) and gait functional mobility (Timed Up and Go [TUG] test), measured at the time of discharge from the rehabilitation unit, were the primary outcomes. The candidate predictors were the cognitive and psychological variables collected in the presurgery phase, together with other potentially informative measures such as age, education, perceived pain, body mass index, presurgical gait speed and functional mobility. Results Our results suggest the existence of a direct relationship between cognitive functioning, with specific reference to high-level frontal executive functions, and the postoperative gait progress: the better the cognitive functioning in the preoperative phase, the better the course of recovery in terms of gait speed and functional mobility. In particular, the performance of the Frontal Assessment Battery test, together with age, perceived pain. Presurgical gait speed and functional mobility, was the best predictor of recovery of walking measured by 10MWT and TUG. Conclusions The present study highlights the importance of cognitive functioning, together with clinical and demographic features, in the postsurgical recovery of walking, even in the absence of cognitive decline. In particular, these data show the crucial role of higher-order cognitive processes, such as executive functions, involved in the formulation of motor plans and their integration with proprioceptive and visual cues.

In reinforced concrete (RC) multi-storey buildings, the important role of the seismic interaction of structural frames with masonry infills has been revealed by several earthquakes and investigated by many authors. Recently, several innovative infill solutions have been proposed to mitigate such interaction, which could result in widespread damage in both the masonry and the RC structure and sometimes jeopardize the building stability and the occupants’ safety. One solution consists in the partitioning of the masonry infill into several sub-panels, relatively sliding along specific joints. This paper investigates the seismic assessment of this technological solution in the framework of performance based earthquake engineering. A two-dimensional five-storey RC seismic-resistant frame is selected as case study and the performance is assessed by comparing the responses of the same structure infilled with different solutions, made of sliding joints or traditional masonry, or in the bare configuration. Incremental Dynamic Analyses (IDA) is used for the probabilistic determination of fragility curves of the structures. Results show the seismic fragility and reliability of the different investigated structures, especially addressing the probabilities of occurrence of damage at different limit states and quantifying the associated expected annual loss.

This is a compact review of recent results on supersymmetric Wilson loops in ABJ(M) and related theories. It aims to be a quick introduction to the state of the art in the field and a discussion of open problems. It is divided into short chapters devoted to different questions and techniques. Some new results, perspectives and speculations are also presented. We hope this might serve as a baseline for further studies of this topic., Facultad de Ciencias Exactas, Instituto de Física La Plata

Beach nourishments protected by submerged sand bag barriers have been largely used in Emilia Romagna (Italy), whose low and sandy coast faces the relatively mild Northern Adriatic Sea. The paper, after a brief description of the eight projects of this type realised in the last 25 years along the Emilia Romagna littoral, details the case study of Riccione Southern beach. The performance of the defence is described by means of cross-shore profiles, bathymetries, collection of sediment samples, underwater pictures, monitoring of environmental conditions and performed maintenance. The combined analysis of the available data suggests that the sand bag barrier may stabilise the position of the natural sandy bar and ultimately the beach profile.

Persistent positivity of HPV-DNA testing is considered a prognostic index of recurrent disease in patients treated for CIN2+. HPV detection, and particularly genotyping, has an adequate high rate of sensitivity and specificity (along with an optimal reproducibility), for accurately predicting treatment failure, allowing for an intensified monitoring activity. Conversely, women with a negative HPV-test 6 months after therapy have a very low risk for residual/recurrent disease, which leads to a more individualized follow-up schedule, allowing for a gradual return to the normal screening scheme. HPV testing should be routinely included (with or without cytology) in post-treatment follow-up of CIN2+ patients for early detection of recurrence and cancer progression. HPV genotyping methods, as a biological indicator of persistent disease, could be more suitable for a predictive role and risk stratification (particularly in the case of HPV 16/18 persistence) than pooled HPV-based testing. However, it is necessary to be aware of the performance of the system, adhering to strict standardization of the process and quality assurance criteria.

Background Over the last two decades it has become clear that distinct types of human papillomavirus (HPV), the so-called high-risk types (hrHPV), are the major cause of cervical cancer. The hrHPV-DNA testing has shown excellent performance in several clinical applications from screening to the follow-up of conservatively treated patients. Methods We conducted a systematic review of the recent literature on the performance of HPV DNA testing in follow-up after treatment of high-grade cervical lesions, adenocarcinoma in situ, and microinvasive carcinoma compared to Pap smear cytology. Results Observational studies have demonstrated that the high risk hrHPV-DNA test is significantly more sensitive (95%) compared to follow-up cytology(70%) in detecting post-treatment squamous intraepithelial high-grade lesions. Moreover, in patients treated conservatively for cervical adenocarcinoma in situ, the hrHPV-DNA test is the most significant independent predictor of recurrent disease or progression to invasive cancer, and the combination of viral DNA testing and cytology reaches 90% sensitivity in detecting persistent lesions at the first follow-up visit and 100% at the second follow-up visit. The cause of microinvasive squamous cervical carcinoma is increasingly treated with conservative therapies in order to preserve fertility, and an effective strategy allowing early detection of residual or progressive disease has become more and more important in post-treatment follow-up. Primary results seem to indicate that the median time for viral clearance is relatively longer compared with patients treated for CIN and suggest a prolonged surveillance for these patients. However, the potential clinical value of HPV-DNA testing in this clinical setting needs to be confirmed by further observations. Conclusions The excellent sensitivity, negative predictive value, and optimal reproducibility of the hrHPV DNA testing, currently is considered a powerful tool in the clinicians' hands to better manage post-treatment follow-up either in cervical squamous lesion or in situ adenocarcinoma.

Since the introduction of biomolecular testing for the identification of high-risk human papillomavirus DNA (hrHPV-DNA) in cervical cancer preventive strategies, many interesting aspects have emerged in this field; firstly, HPV-DNA testing has been demonstrated to have better sensitivity than conventional cytology in several settings: screening, triage of ASC-US and in follow-up after treatment. Despite this, some limitations of these new technologies have also been underlined: the major issue is the low specificity of the tests, which cannot discriminate between regressive and progressive infections. Thus, recent research has moved the attention towards novel markers of progression that could more precisely detect cases at real risk of cancer development. In view of the fact that progression to cancer is dependable of the E6/E7 proteins integration and transforming action, the overexpression of E6/E7 transcripts has been seen as a valuable marker of this risk. This review aims to summarise the literature data on this topic and to provide a clear view of the emerging perspectives.